13 Feb School Based Healthy Lifestyle Program Did Not Bend Childhood Obesity Curve
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Childhood obesity is an increasing problem worldwide. In the UK, the proportion of children who are very overweight doubles during the primary school years. Furthermore during this period inequalities emerge. At school entry there is little difference in the likelihood of being overweight between groups. However on leaving primary school, children from minority ethnic groups and those from more deprived, compared to more affluent backgrounds are more likely to be overweight. Excess weight in children is linked with multiple health, emotional and social problems. As children spend a lot of time at school, it seems intuitive that they are an ideal setting for prevention interventions.
Although a number of studies have investigated the evidence for school obesity prevention programmes, the results have been mixed and methodological weaknesses have prevented recommendations being made. As a result we undertook a major high quality trial to evaluate an intervention that had been developed in consultation with parents, teachers and the relevant community. The 12 month programme had four components. Teachers at participating schools were trained to provide opportunities for regular bursts of physical activity for children, building up to an additional 30 minutes each school day. There was also a workshop each term, where parents came in to cook a healthy meal (breakfast, lunch of dinner) with their children. In conjunction with a local football club, Aston Villa, children participated in a six-week healthy eating and physical activity programme. Finally, parents were provided with information about local family physical activity opportunities.
We involved around 1500 year 1 children (aged 5-6 years) from 54 state run primary schools in the West Midlands. At the start of the study, we measured their height and weight and other measures of body fat, asked the children to complete a questionnaire about their wellbeing, to note everything they ate for 24 hours, and to wear an activity monitor that recorded how active they were. After this, the schools were randomised to either receive the programme or not. We then repeated the measures 15 and 30 months later.
MedicalResearch.com: What are the main findings?
Response: Our results showed no convincing evidence that any measures were different between children in the schools that did, or didn’t receive the programme after 15 or 30 months.
MedicalResearch.com: What should readers take away from your report?
Response: Healthy lifestyle programmes like the one we evaluated, are unlikely to impact on childhood obesity. Some individuals and groups did have benefits from the programme, and overall the children and teachers enjoyed the activities. However, in terms of obesity prevention, these programmes alone are unlikely to have a large effect. Interviews with teachers, parents and children suggested that other influences, such as the family, wider community environment, food advertising, the media and food industry promotions and pricing structures may be more important than what happens in school. Focusing on one element in isolation is unlikely to be effective. We need a co-ordinated effort across all the levels of influence.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: It is worth evaluating school efforts within the wider system of interacting influences and assessing whether co-ordinated approaches across multiple levels of influence are more effective. It is also worth investigating more focused interventions.
MedicalResearch.com: Is there anything else you would like to add?
Response: Our findings relate to a situation in the UK, which is similar to many other developed countries at an advanced stage of the obesity epidemic. School based interventions may still be useful in settings where the obesity epidemic is at an early stage, and it is important to evaluate such interventions in other settings.
Disclosure: The trial was funded by the NIHR HTA programme.
I also have other research funding for childhood obesity prevention research from NIHR, Birmingham City Council, China Medical Board and Yong Ning Pharmaceuticals Ltd
Adabe P, et al “Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6-7 year old children: the WAVES study; a cluster-randomised controlled trial” The BMJ 2018; DOI: 10.1136/bmj.j3984.
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